More than 100 days into the U.S.-backed Israeli offensive in Gaza, women in the besieged Palestinian enclave are giving birth in overcrowded shelters or tents, premature babies are dying without access to hospital incubators, and dire food shortages are leaving newborns malnourished.

Despite promises by the U.S. and other governments to use a United Nations Security Council resolution passed last month to dramatically increase humanitarian aid for Gaza, aid experts say they have yet to see a real improvement — instead, they say, conditions are worsening. Meanwhile, President Joe Biden’s special humanitarian envoy for the crisis is preparing to leave office, and an internal U.S. government estimate circulated this week identified that Israel, which is receiving huge American support for its fight against the Gaza-based militant group Hamas, is barring aid for some of the most desperate people in Gaza, including some who have ties to the U.S.

“Whatever marginal improvement there has been … it’s nowhere near the scale that’s required at this point. Where there are improvements, they’re modest and fragile — they could be undone by Israeli military actions or Israeli political decisions,” said Jeremy Konyndyk, the president of the nonprofit Refugees International, who previously worked on humanitarian issues in the Biden and Obama administrations.

Critical reproductive and maternal health care have especially deteriorated, according to CARE, a humanitarian organization focused on helping women and girls in conflict.

In Rafah, the city in southern Gaza where tens of thousands of people fled amid Israeli evacuation orders, there’s now only one active hospital that was designed to accommodate 30 to 40 daily appointments for pregnant patients, CARE’s Nour Beydoun told HuffPost. The hospital now sees about 300 to 400 pregnant women, postpartum mothers and newborns each day. The facility only has one operating room, which was initially made to handle two to three cesarean sections per day, but now accommodates nearly 20 C-section deliveries daily.

Amid ongoing Israeli bombardment, 26 of Gaza’s 35 hospitals have shut down. The Palestinian territory is home to around 55,000 women who are currently pregnant, CARE reported, mostly relying on figures from the United Nations’ Office for the Coordination of Humanitarian Affairs (OCHA), which shares daily situational reports and statistics. Many of those who have to undergo C-sections will likely have to do so without anesthesia or sanitary medical tools, which often leads to wound infections.

“There is no doctor, midwife, or nurse to support women during labor. There is no pain medication, anesthesia, or hygiene material when women give birth,” Hiba Tibi, CARE’s acting deputy regional director for the Middle East and North Africa, said in a statement last week.

“‘Will I survive childbirth? Will my child survive? What will happen to my other children?’ These are very real dangers pregnant women and young mothers in Gaza have faced for the past 100 days, with no end in sight,” Tibi said.

Women in Gaza have experienced a 300% increase in miscarriage due to the lack of neonatal and maternal health care in the region, CARE reported via the Al-Shifa Hospital manager in Gaza City.

A lack of menstrual hygiene products has caused an increase in infections in women and girls who are using unsanitary fabric or clothing while on their periods, Beydoun told HuffPost. CARE created 3,500 “dignity kits,” which include menstrual hygiene materials and products as well other essentials like nail clippers and hair brushes. The kits are being prepared for transport to Rafah, but Beydoun said it’s unclear if CARE will be able to get anything over the Gaza-Egypt border and distributed.

Secretary of State Antony Blinken called the suffering in Gaza “gut-wrenching” this week in remarks at an annual confab of the global elite in Davos, Switzerland.

But the U.S.’s own estimates suggest its efforts to help are not bearing fruit. A State Department document that a U.S. official described to HuffPost reported that the situation in northern Gaza — where Israel has said it has wound down major military operations — had not improved as of Jan. 16. The document highlights that Israeli Defense Forces have denied multiple proposals to move supplies, including fuel and medicine, into the region, where 300,000 Palestinians still live, the U.S. official said, and the State Department believes some relatives of American citizens are stuck there and running out of water and food.

A spokesperson for Israel’s Embassy in Washington did not respond to a request for comment for this story.

The Biden administration has shied away from criticizing Israel or suggesting it would reduce support for the U.S. ally if it does not smooth out the process of letting in humanitarian assistance. It’s also been careful in its statements about Egypt, which plays a big role in processing supplies into Gaza through its southern border.

A State Department spokesperson told HuffPost: “The United States — at all levels of the government — continues to press on the need for more humanitarian assistance into Gaza as well as commercial goods with all regional actors as well as the United Nations, including Israel. The President, Secretary, and other senior officials engage regularly on these questions.”

“Secretary Blinken’s travel to the region last week strongly focused on efforts to minimize civilian harm in Gaza and accelerate and increase the delivery of humanitarian assistance to Palestinian civilians throughout Gaza,” the spokesperson wrote in an email. “We know more assistance is needed and continue working with regional actors to expand humanitarian and commercial deliveries and access.”

Konyndyk challenged the Biden administration’s narrative.

“When the U.S. government is defending their record on this, their basic argument is they’re making some incremental improvements … That’s like saying, ‘We got three more buckets to fight the forest fire.’ Whatever improvement that reflects, the pace of it is far, far outmatched by the rate of deterioration in the humanitarian situation,” Konyndyk said. “The U.S. position on this is that none of the concessions from Israel would be happening without us. I think that’s right. That is different from saying the concessions the Israelis are making are even remotely adequate to the scale of the crisis and they’re not.”

“When you’re in a famine situation — which is what Gaza’s facing now — you need overwhelming force. You need the humanitarian equivalent of shock and awe,” he continued.

‘There’s Been A Beaten-Downness’

Even for experienced aid groups, it’s nearly impossible to fully understand the political sensitivities around Gaza, which Hamas has ruled since 2007. Israel and Egypt have subjected the region to a blockade since then that tightened after Hamas’ Oct. 7 attack on Israel. Those considerations — rather than problems of supply or logistical feasibility — are driving the disaster in the region, observers say.

Sean Carroll, a former senior U.S. official who runs the Palestinian-focused relief organization Anera, described conversations with counterparts who had helped with other humanitarian crises. They “can’t believe” how challenging it is to push the U.S., Israel, Egypt and other players to ramp up an appropriate aid response, said Carroll, who visited Gaza last month and described seeing “many people living in far too precarious conditions” given the lack of clean water and cramped conditions.

“There’s been a beaten-downness over the years … I’m pushing everyone, including our own team, who are used to hearing ‘no’ — we all have to push each other and push the Israelis and take people at their word when they say they want to do more,” he added. He said his team has discussed unorthodox ways to rush more supplies into Gaza, like bringing them by sea or by helicopter or by opening up more entry and inspection points given Israel’s concern that Hamas or other militants could use materials in aid to enhance their military capability.

The December U.N. resolution the U.S. helped craft — and watered down — was expected to bolster pressure for a surge in assistance through the appointment of a U.N. coordinator.

“The evidence is clear: It’s been useless,” Dave Harden, a former senior U.S. official who worked in Israel-Palestine, told HuffPost.

Backers of the resolution say it still has potential but governments have to shore it up.

The United Arab Emirates, a close U.S. partner in the Middle East and the Arab state on the U.N. Security Council at the time the resolution passed, played a major role. Lana Nusseibeh, the UAE ambassador to the U.N., told HuffPost the resolution endorses “a streamlined aid operation” and the coordinator it put in place — former Dutch Foreign Minister Sigrid Kaag — “has hit the ground running.”

“The resolution is the first since 2016 to reaffirm the Council’s commitment to the two-state solution and the first to stress the importance of unifying the Gaza Strip and West Bank under Palestinian leadership. Resolution 2720 clearly establishes the conditions under which aid should be delivered, and if it is adhered to, the humanitarian situation in the Gaza Strip would improve dramatically,” Nusseibeh said. “It is on everyone who passed this resolution ― especially the Security Council ― to ensure it is implemented and to push all parties to the conflict, in particular Israel, to respect their obligations.”

‘Incremental Progress’

The U.S., a permanent Security Council member, is widely seen as the only player that can exercise influence over Israel.

Much of the day-to-day work of encouraging greater cooperation from the Israelis and to some extent the Egyptians is carried out by David Satterfield, a retired ambassador who Biden appointed to his special envoy post in October. Satterfield is poised to step down from this post, a source told HuffPost last week.

State Department spokesperson Matt Miller denied that Satterfield plans to leave his role. “It’s not possible to overstate the impact Ambassador Satterfield has had in getting humanitarian aid into Gaza and directly to Palestinians,” he told HuffPost. “Since his appointment, he has worked around the clock, shuttling back and forth between Israel, Egypt, and Jordan to advocate for expanding the scale of humanitarian assistance and commercial goods, and coordinating their movement into Gaza.”

“While this vital aid has undoubtedly saved lives, no one is satisfied with the situation as it stands today, which is why he continues to work on increasing that flow of aid with partners, including trying to get more commercial goods into Gaza,” Miller added.

Some aid groups and experts are deeply disappointed in Satterfield, who controversially suggested moving Palestinians into Egypt in an internal U.S. government conversation revealed by HuffPost and did not respond to requests for meetings from at least three Gaza-focused humanitarian organizations.

Miller said it was “completely false and untrue” that Satterfield ever proposed that idea and added: “The U.S. position has consistently and unequivocally been opposed to the forced displacement of Palestinians from Gaza.” Miller also said Satterfield “and his team have engaged humanitarian groups across the spectrum.”

An official at a humanitarian group who requested anonymity to maintain professional relationships described sympathy for the position Satterfield is in, considering Biden’s overall refusal to pressure Israel.

Giving him credit for “incremental progress,” the official said: “He has not had a lot of political leverage with which to do it … so [Israeli Prime Minister Benjamin] Netanyahu basically knows that as long as he throws them a bone once in a while, he can ignore the fundamental substance.”

“Famine will not be averted under the current diplomatic approach,” the aid official continued.

Harden, the former senior U.S. official who worked in Israel-Palestine, was also deeply dismayed by the U.S. government’s current response to the ongoing war.

“If results matter in policy, then the results that we have right now in Gaza are horrific … that’s where we are one month later from the U.N. resolution, that’s where we are three months after Satterfield’s appointment, that’s where we are in the Biden administration,” he said. “Overall, this is a failure.”